Functional Neurosurgery

The Department’s Division of Functional Neurosurgery treats patients with treatment resistant neurological disorders, such as epilepsy, Parkinson’s disease, essential tremor, chronic pain and spasticity. The Division is managed by Dr. Ashwini Sharan, an internationally recognized leader in the field.

Epilepsy

The surgical division of the Jefferson Comprehensive Epilepsy Center benefits from one of the largest referral bases and clinical volumes in the country. Procedures regularly performed for the treatment of epilepsy include:

Implants for long-term invasive monitoring

Stereotactic EEG

Resective surgeries, such as lobectomies and seizure focus resection

Disconnection surgeries, such ascorpus callosotomy

Vagal nerve stimulator (VNS) implants

Responsive neurostimulator (RNS) implants

Stereotactic laser ablation

A weekly epilepsy conference is held to discuss all potential surgical candidates. The multidisciplinary conference includes neurosurgeons, epileptologists, neuropsychologists and neuroradiologists. During this conference, and through clinical exposure, residents and fellows are learn the essential elements of seizure management, how to interpret EEGs and similar neurophysiological tests, identifying suitable surgical candidates and the perioperative management of this patient population. In the operating room, trainees are directly exposed to various surgical techniques.

Faculty members actively engage in multiple research projects, which are performed in collaboration with other epilepsy centers across the United States.

Movement Disorders

Patients with movement disorders, such as Parkinson’s disease, dystonia and essential tremor, are generally treated by Deep Brain Stimulation (DBS) after medical management has failed. Specific procedures performed include:

Residents and fellows benefit from clinical exposure and a monthly movement disorder conference. During this conference, held between neurosurgery and neurology, physicians discuss possible DBS candidates. This provides an ideal forum for students to gain a deeper understanding of the pathophysiology of movement disorders, recognizing important clinical findings, identifying potential DBS candidates and the perioperative management of this population. Trainees are also exposed to the principles of stereotaxy, since they are involved in the planning and execution of DBS. In the operating room, In the operating room, nuances of the procedure and the integration of microelectrode recordings are emphasized.

Chronic Pain

The Division routinely evaluates patients experiencing chronic pain that has not been adequately managed by conservative therapies. Procedures performed for chronic pain include:

Our neurosurgeons work closely with pain specialists from anesthesiology and neurology, physiatrists, oral and maxilliofacial surgeons and other spine surgeons to ensure that patients are thoroughly evaluated before a functional neurosurgical procedure is deemed necessary. Students benefit from our large volume and multidisciplinary approach, as they learn to care for these patients both in and out of the operating room. Faculty members actively engage in both clinical and basic science research projects to further our understanding of pain pathways and improve clinical outcomes.

Spasticity

Our specialists can help treat patients suffering from spasticity by implanting intrathecal baclofen pumps. Patients are considered for implantable pumps after oral baclofen has proven either ineffective or intolerable. Patients with the following conditions are considered for implantable baclofen pumps:

Cerebral palsy

Multiple sclerosis

Spinal cord injury

Traumatic brain injury

Our neurosurgeons work closely with psychiatrists and neurologists to ensure that patients have exhausted other treatments before considering a surgical approach. This close collaboration affords trainees the opportunity to learn how to manage these patients both in and out of the operating room.

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